Karn Extraordinary Smiles

Are dental x-rays safe and necessary?

Many people are concerned about the potential health effects of dental x-rays. As a doctor trained in both dentistry and natural medicine, I share that concern. Environmental exposure to radiation may have detrimental effects on the human body. My goal is to balance the enormous diagnostic benefits of x-rays with any potential risk.

When all sources of environmental exposure to radiation are considered, dental x-rays contribute less than 0.1% to the overall burden while medical exposure contributes 20%. The impact of dental x-rays is so low that when experts calculate the “estimated genetically significant dose” from medical procedures, dental exposure is not even considered.

On any given day our entire bodies are exposed to significant doses of background radiation. By comparison, a single dental x-ray is equivalent to 0.075 days of environmental exposure. However, a standard medical CAT Scan exposes you to 10,000 times the average daily background exposure.

As you can see, the radiation exposure from dental x-rays is extremely small. Despite the minimal exposure risk from dental x-rays, we still only recommend them when we feel the potential benefit outweighs the very small risk.

What is your opinion about fluoride?

The use of fluoride, and particularly fluoridation of drinking water, has been touted for the last few decades as a huge boon to dental health. Dental societies and public health agencies have vigorously promoted water fluoridation as one of the most beneficial public health policies ever introduced. We are not convinced.

We believe that an objective and thorough review of the relevant science shows the toxic properties of fluoride have been grossly overlooked, and the benefits of fluoridation have been widely overrated. Simply stated, fluoride is toxic and likely doesn't work as it’s been promoted. If you'd like more information on this point of view refer to one of the factual and reliable websites on this topic: www.fluoridealert.org. Only upon specific request do we provide "fluoride treatments" on kids or adults. We do not support public water fluoridation. We do not prescribe fluoride supplements.

Are root canals a good idea?

Root canal treatment is another area of current controversy. The rationale for this treatment is to save a tooth where the nerve has become irreversibly damaged or infected. Under these conditions the only other option is to extract the tooth. Of course, dentists are always in favor of saving teeth. On one hand it can be said that root canal treatment has saved millions of teeth from extraction, and allowed them to function comfortably and esthetically. On the other hand, some dentists and scientists are asking the question—at what cost?

Again, this is a long and complex story. The short version goes something like this—teeth that have been saved with root canal treatment, even when the treatment looks and feels successful from all traditional criteria, may still harbor residual toxins that can enter the bloodstream and affect the body as a whole. Dr. Weston Price did the original research calling attention to this issue in the 1920s. Dr. George Meinig summarizes his work in a recent book, Root Canal Cover-up Exposed. Very little modern research has been applied to this question. The one outstanding exception is the current work of Dr. Boyd Haley and Dr. Curt Pendergrass at Affinity Labeling Technologies. Their sophisticated research has confirmed that many root canal treated teeth still have significant toxic potential. Their research is presented at www.Altcorp.com.

Two questions naturally arise from this controversy: 1) Should root canal treatments be done at all? 2) Are existing root canal treated teeth a health risk and should they be extracted? At the present time, we don't feel these questions have a clear-cut answer. Should this situation arise, we advise patients on an individual basis. The International Academy of Oral Medicine and Toxicology has a standing committee on root canal concerns, and they have been wrestling with this issue. Currently, they still have no consensus on the simple core question: root canals -yes or no?

Do you take my insurance?

Our goal is to always help you maximize your dental insurance coverage. Please keep in mind that the prime mandate of insurance companies is cost containment – a strategy that does not necessarily equate to high quality dental care. Because of this, we are not a defined provider for any specific insurance company. However, our office does accept all insurance plans, as long as your coverage allows you to select a dentist of your choice.

I have unexpected dental needs... do you have any extended payment arrangements?

Our mission is to deliver the finest dental care available today. High quality dentistry is an excellent investment in your health and well being. We believe that financial considerations should not be an obstacle to obtaining the treatment you desire. We have a variety of payment options to help make quality dental care affordable. We do accept all major credit cards, though many of our patients choose to pay for their dental investment over time. We work with companies such as Wells Fargo Bank and Care Credit who provide credit options specifically for dental procedures. Once a treatment plan has been agreed upon, our business office can contact either company on your behalf. In some cases your approval status will be determined in less than five minutes! The handling of the entire process is discrete and held to the highest standards of privacy.

These companies offer the following benefits:

• 12 month no interest options
• Low monthly payments
• No prepayment penalty

Do you offer price quotes over the telephone?

That’s almost impossible to do. It’s a lot like asking how much a car costs without having any idea about the make, model or desired options. Because a full conversation and a complete dental analysis are needed, we ask that you please come in for a consultation. We know you’ll be glad you did.

How are inlays and onlays different from crowns?

When a tooth needs more structural support than a filling can provide the treatment options include an inlay, onlay or a crown. Inlays and onlays strengthen and protect the tooth just like a crown. The main difference is that inlays and onlays require removal of only the damaged and decayed areas of the tooth while crowns often require removal of additional healthy tooth structure. The bottom line—inlays and onlays are the most conservative and healthy option when a tooth needs more structural support than a filling can provide. They are our treatment of choice when this situation arises. We only suggest crowns when decay or trauma extensively damages a tooth such that inlays or onlays are technically impossible.

What are the environmental concerns associated with mercury silver fillings?

It is well established that mercury is a significant environmental contaminant. Millions of dollars are spent on cleaning up toxic industrial mercury spills. A dirty little secret is that the dental industry is spilling a significant amount of mercury into the environment!

Wastewater treatment agencies in several parts of the U.S. and Canada recently have been studying this problem. They find that wastewater entering the municipal treatment plants often contains unacceptable levels of heavy metals—including mercury. Wastewater treatment plants are not designed to process heavy metals. It is important that this contamination is cut off at the source. Their studies have estimated that up to 80%of the mercury contamination of wastewater entering the treatment plants is coming from dental offices!

How does this happen? Any time a mercury amalgam filling is placed or removed, there is a significant amount of amalgam sludge that is vacuumed up by the dental assistant. It doesn't just disappear. That mercury-laden sludge goes down the drain and into the wastewater system. In most offices, this goes completely unchecked. Several European countries have had regulations for years that require dental offices to be equipped with special mercury-separator devices that filter out or trap mercury before the wastewater leaves the dental office. In the near future, such regulations will take effect in some Canadian cities, and it is likely that parts of the U.S. will follow suit.

We are proud to say that we have had such a wastewater protective service in place for several years. It's a simple step that makes a significant environmental impact.

What’s so different about the way you treat gum disease?

Gum disease is an infection caused by chronic bacterial infection of the gum tissue. This infection damages the gum and bone that support the teeth. Recent advances in technology now permit the use of a dental laser to painlessly and non-surgically treat this infection and stimulate the body to heal. We are one of the only dental practices in the Inland Northwest using this advanced technology.

What’s involved in mercury amalgam filling replacement?

Safe mercury amalgam replacement is more complex than traditional metal based dentistry. If you decide to replace your mercury amalgam fillings, have it done by a dentist who is experienced with, and committed to, mercury-free dentistry.

Amalgam fillings contain over 50% mercury. During the removal of amalgam fillings, the mercury component of the filling is vaporized and the patient can be exposed to amounts one thousand times greater than the EPA allowable air concentration. Amalgam removal needs to be done cautiously to protect the patient from exposure to additional mercury during the course of the dental procedures. This is a very important point and one that is likely to be overlooked by most dentists who are not committed to mercury-free dentistry.

Your health and safety are our primary concern. We take every precaution possible during amalgam filling replacement to protect you, my dental team and myself from additional exposure to mercury. We adhere to the following protocol established by the International Academy of Oral Medicine and Toxicology. These steps have been shown to greatly reduce everyone’s exposure to mercury during amalgam filling replacement.

1. Keep fillings cool—Remove fillings under copious amounts of cold-water spray to minimize the heat-induced release of mercury vapor from the fillings. Our dental drills spray water from 3 ports rather than the standard single port.
2. Section and remove the filling in large pieces.
3. Use a high volume suction aspirator to evacuate mercury vapor as it is released.
4. Provide alternative clean air source. All patients having amalgam removed are provided with oxygen delivered through a nasal hood.
5. Use a rubber dam. A rubber dam is a latex shield placed over the tooth that helps prevent breathing or swallowing mercury vapor or fragments during filling removal. All particles of mercury amalgam that collect on the rubber dam are washed and vacuumed away as soon as they are generated.
6. Keep the room air pure—All dental offices using or removing mercury fillings should install room air purifiers. You would be alarmed at the amount of mercury vapor in the air of a typical dental office. It enters the air each time a mercury amalgam filling is placed into a tooth or removed from a tooth. Our dental office is equipped with a state of the art clean air system that collects any mercury vapor that escapes into the air during amalgam filling removal. This protects everyone who enters our dental office from being exposed to airborne mercury vapor.

Should I have my mercury silver fillings replaced?

Our recommendation is that you never allow another amalgam filling to be placed in your mouth—of course that would never happen in our office. The decision to replace amalgam fillings that are already in your mouth needs to be carefully considered. There are many reasons to consider the replacement of your existing amalgam fillings:

• Many of our patients come to us because their physician feels that they may have some health problems where mercury exposure or accumulation may be part of the problem. As an adjunct to their medical treatment, the physician recommends having their amalgam fillings carefully replaced with a more biocompatible material.
• Some people come to us because they have read and learned enough about mercury issues that they have decided they don't want this material in their mouths anymore and request that we replace it.
• Still others understand that mercury silver fillings are an obsolete material. They have learned that these fillings will eventually damage the underlying tooth structure and have elected to replace them with modern materials before irreversible damage has occurred.

In our opinion, any of these is a wise and valid reason for replacing the old mercury amalgam. We won't take the position that everyone in our office should replace all his or her previous amalgam fillings. We do, however, feel a responsibility to educate everyone on the issues surrounding mercury fillings and to let them know that a mercury-free mouth is always available in our office. It's always your choice—however, we think it's a pretty good choice for most people. Dr. Karn wouldn't allow mercury amalgam to be in his mouth, or in the mouths of his family or team.

Please notice, I am not saying that if you replace your amalgam fillings you will experience any specific health benefit. However, many of our patients report they have experienced significant, positive health changes when they have followed closely the amalgam replacement protocols described below. But that experience is by no means universal, and we want to be clear that we are making no specific health claims for replacing amalgam fillings. At the very least, you'll be reducing your body burden of a known toxic material, updating your old fillings with modern materials and preventing the eventual tooth related damage caused by amalgam silver fillings.

Why has Dr. Karn chosen to avoid the use of mercury silver fillings (amalgam)?

Our commitment to state-of-the-art, advanced dentistry, precludes the use of silver filling material (called amalgam) to restore your teeth. These are some of the reasons why:

• Amalgam or “silver” dental fillings contain 50% mercury.
• Mercury is a one of the most toxic substances known on earth. World renowned mercury toxicologists state that no amount of exposure to mercury vapor can be considered harmless.
• There are no studies proving that amalgam is safe when placed in the human body. In fact, amalgam has never been subjected to FDA testing. If it were being introduced today, it is highly unlikely that it would ever receive FDA approval as a dental device.
• OSHA and the EPA classify dental amalgam as a hazardous and toxic waste. They mandate that all amalgam removed from your tooth must be stored in a specialized container to prevent personal and environmental exposure to the continuous release of hazardous mercury vapor.
• Scientific research has demonstrated that mercury, even in small amounts, can damage the brain and nervous system, heart, lungs, liver, kidneys, thyroid gland, pituitary gland, adrenal gland, blood cells, enzymes and hormones. Mercury is also known to suppress the T-cells of immune system by as much as 100%.
• Mercury readily passes through the placental barrier in pregnant women and can cause permanent damage to the brain of the developing baby. Mercury appears in the amniotic fluid just two days after placement of an amalgam filling in a pregnant woman. Mercury is also concentrated in breast milk.
• Mercury vapor is continually released from mercury dental fillings. The release of mercury can be increased as much as 15-fold by chewing, brushing, eating acidic foods and drinking hot liquids.
• The World Health Organization has concluded that the daily intake of mercury from amalgam fillings exceeds the combined daily intake of mercury derived from air, water and food (including fish). Studies by the National Institute of Health confirm a direct correlation between mercury levels in a person’s blood, urine and stool and the number of amalgam fillings in their teeth.
• Mercury vapor released from amalgam fillings is rapidly absorbed and accumulated in body tissue.
• In human autopsy studies, it has been found that there is a direct correlation between the amount of mercury found in the brain and the number of mercury fillings in the teeth. Scientific research has shown high levels of mercury in the brains of individuals dead from Alzheimer’s disease. Mercury has been shown to effect the brain in ways similar to Lou Gehrig’s Disease, Parkinson’s, Multiple Sclerosis, Autism and Alzheimer’s disease.
• Placing amalgam fillings often requires drilling away large amounts of healthy tooth structure. These fillings can profoundly weaken the tooth and often lead to the placement of much larger fillings, crowns and, in many cases, root canals.
• Modern dental materials now exist that are more biologically compatible than dental amalgam. When placed with meticulous attention to detail, the new materials are highly cosmetic and can reinforce the tooth. By using these techniques, we may be able to prevent fractured teeth and the need for some root canals and crowns.

What’s the problem with mercury silver fillings (amalgam)?

Mercury fillings, euphemistically called "silver" or "amalgam" fillings, have been used in dentistry since the Civil War era. They are an amalgam of 50% mercury, mixed with silver, copper, tin and other metals. Mercury fillings were invented as a cheap alternative to gold. Because they are easy to place and inexpensive, mercury fillings have been widely used for 150 years. So, what’s the controversy?

• By volume, amalgam fillings contain over 50% mercury—one of the most toxic substances on earth.
• Mercury amalgam technology is ancient by modern medical standards. Mercury amalgam was standardized for manufacture in 1895 and dentists have been using it to fill teeth for at least 160 years.
• Mercury silver fillings do not bond (stick) to the tooth structure. This requires the dentist to wedge the filling into the tooth to keep it from falling out. However, creating this wedge effect requires the removal of excessive amounts of healthy tooth structure—weakening the tooth and predisposing it to cracks and fracture.
• The lack of a bond between the filling and the tooth permits bacteria to leak underneath the filling. This creates decay that is often not detected until the tooth has been further damaged.
• Just like in a thermometer, the mercury part of the filling expands and contracts. These expansion and contraction cycles wedge the tooth apart. Eventually the tooth will fatigue, crack and split. Repairing a cracked tooth usually requires either a root canal and/or a crown.

In contrast, modern tooth-colored restorations are adhesive, highly cosmetic and mercury-free. These esthetic restorations are strongly bonded to the tooth using a state-of-the-art technique that intimately binds the material to the surrounding tooth structure. Using these advanced materials and techniques we can restore the original strength and beauty of the tooth.